10.07.09.02

.02 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) Abuse of a Resident.

(a) "Abuse of a resident" means:

(i) The nontherapeutic infliction upon a resident of physical pain or injury, for example, striking a resident; or

(ii) A persistent course of conduct intended to produce, or resulting in, mental or emotional distress to a resident, for example, verbal intimidation of a resident.

(b) "Abuse of a resident" does not mean the performance of an accepted medical procedure ordered by a physician or administered by another licensed health care professional practicing within the scope of the physician's or health care professional's license.

(2) "Abuse of funds" means the misappropriation of a resident's assets or income. Misappropriation includes spending the resident's assets or income:

(a) Against or without the resident's consent, or, if the resident is incapable of giving consent and has no agent with authority to give consent, when the expenditure is not necessary for the direct and immediate benefit and welfare of the resident; or

(b) For the use and benefit of a person other than the resident, if the resident or agent has not consented to the expense.

(3) "Agent" means a person who manages, uses, or controls the funds or assets that legally may be used to pay an applicant's or resident's share of costs or other charges for the facility's services.

(4) "Certified" means the designation attached to a nursing facility that has met the requirements for participation as a skilled nursing facility in the Medicare Program or as a nursing facility in the Medicaid Program.

(4-1) "Change in condition" means a significant change in the resident's physical, mental, or psychological status including, but not limited to:

(a) Life-threatening conditions such as heart attack or stroke;

(b) Clinical complications such as the:

(i) Development of a pressure sore;

(ii) Onset or recurrent periods of delirium;

(iii) Onset of recurrent urinary tract infection;

(iv) Onset of depression; and

(v) Onset of aggressive or inappropriate behavior;

(c) The need to discontinue a medication or treatment because of:

(i) Adverse consequences; or

(ii) The need to begin a new form of treatment;

(d) Evaluation at or admission to a hospital; or

(e) Accidents that result in injury having the potential for requiring a physician's intervention.

(5) "Chemical restraint" means use of a psychopharmacologic drug to control behavior and not otherwise required to treat medical symptoms.

(6) "Comprehensive care facility" means a nursing facility that admits residents suffering from disease or disabilities or advanced age, who require medical and nursing services rendered by or under the supervision of a registered nurse.

(7) "Consent" means an express agreement by a resident who is capable of making an informed decision or, in cases when the resident is not capable, by the resident's representative.

(8) "Department" means the Maryland Department of Health.

(9) "Director" means the Director of the Office on Aging.

(10) "Disabled resident" means a nursing facility resident who lacks sufficient understanding or capacity to make or communicate a responsible or informed decision on health care or personal finances because of a physical or mental disability, or because of substance abuse.

(11) "Discharge" means the:

(a) Removal of a resident from a nursing facility when the releasing nursing facility is no longer responsible for the resident's care;

(b) Movement of a resident from a certified bed to a noncertified bed;

(c) Movement of a resident from a skilled nursing facility bed under the Medicare Program to a bed not certified under that Program; or

(d) Movement of a resident from a bed certified only for Medicaid to a distinct part of the facility that is a skilled nursing facility under the Medicare Program.

(12) "Emergency" means a situation in which the life, health, or safety of an individual is in imminent and serious jeopardy.

(13) "Extended care facility" means a nursing facility that:

(a) Provides treatment services for residents requiring inpatient care but who do not currently require continuous hospital services; and

(b) Admits residents who:

(i) Require extensive restorative or rehabilitative services, or

(ii) Have a terminal disease requiring extensive nursing care.

(14) Involuntary Transfer or Discharge.

(a) "Involuntary transfer or discharge" means a transfer or discharge of a resident that is initiated by a nursing facility without the consent of the resident or, when applicable, the resident's representative.

(b) "Involuntary discharge" includes a discharge as described in Regulation .12E of this chapter.

(15) "Licensee" means a person licensed by the Department to operate a comprehensive care facility or an extended care facility.

(16) "Licensing and Certification Administration" means the survey and licensing agency, a unit of the Department of Health.

(17) "Neglect" means failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness.

(18) "Nursing facility" means a comprehensive care or extended care facility.

(19) "Office" means the Office on Aging.

(20) "Physical restraint" means a device, including material or equipment, attached or adjacent to a resident's body, that the resident cannot remove easily and that restricts the resident's freedom of movement.

(21) Private Pay.

(a) "Private pay" means a nursing facility's acceptance of payment from a source other than the Medical Assistance Program.

(b) "Private pay" includes reimbursement by the Medicare Program or other third-party insurer.

(22) Relocation.

(a) "Relocation" means the movement of a resident from one room to another within:

(i) The same Medicare-certified facility;

(ii) A Medicaid-only certified nursing facility; or

(iii) A licensed-only nursing facility.

(b) "Relocation" does not mean the movement of a resident if the effect of the movement is to move the resident from:

(i) The distinct part of the nursing facility that is a skilled nursing facility to a distinct part of the nursing facility that is not a skilled nursing facility; or

(ii) A bed that is certified for Medicaid to a distinct part of the nursing facility that is a skilled nursing facility.

(23) "Representative" means a person referenced in Regulation .03 of this chapter.

(24) "Resident" means an individual who is admitted or remains in residence for overnight care in a nursing facility.

(25) "Resident funds" means the assets and income of a resident or nursing home applicant that are under the use, ownership, management, or control of the resident or resident's agent.

(26) "Residents' Bill of Rights" means the statement of basic rights of each resident of a nursing facility as set forth in:

(a) Health-General Article, §§19-343—19-347 and 19-349—19-352, Annotated Code of Maryland;

(b) Title XIX of the Social Security Act, 42 U.S.C. §1396(5)(c);

(c) 42 CFR §483.10 et seq.; and

(d) The regulations in this chapter.

(27) "Transfer" has the meaning as described in §B(11) of this regulation.